The human antenatal and neonatal growth revisited
Oreste Battisti MD, PhD, Academic Professor of Pediatrics, Faculty of Medicine,
University of Liège (Belgium), Department of Pediatrics and neonatal medicine.
Route de l’hôpital, Bat 35 4000 LIEGE (B) Oreste.battisti@ulg.ac.be
Abstract
We made firstly an analysis of several published charts concerning the
human antenatal and postnatal growth. We made an analysis of the absolute
and of the velocity changes in body weight, in length and head
circumference. The fetal curves have a diagnostic purpose on the normality
of growth during the fetal life. They are derived from measurements done
either in utero or at birth and are validated from 25 to 42 weeks. From these
diagnostic charts, the best on a mathematical and statistical point of view is
that by “Dombrowski”. Several other fetal curves can be criticized for not
meeting all the criteria of a statistical normal population, mainly concerning
the body weight. The combined (fetal and postnatal) charts are constructed
from measurements done at birth and longitudinally afterwards: they are
validated from 25 to 60 weeks. The clinicians having in care fragile neonates
(those born before 30 weeks or below 1000g or those combining a
prematurity and a fetal growth restriction) have the important task which is to
give the best nutrition for these neonates and, by the way, to see if the actual
growth is optimal. This can be done by measuring longitudinally the three
parameters of growth and by plotting the results on a combined chart. The
postnatal growth of a premature baby can hence adequately be followed for
they take into account the interruption of fetal life, the necessary adaptation
after birth and the consequent priorities of growth in organs. Among the
combined charts, the “Gairdner” and “Battisti” meet the criteria of a normal
population for all parameters of growth. We made secondly the analysis of
velocity observed in the different parameters of growth (d BW, d BL, d HC)
from 25 to 60 weeks of age. The analysis concerned their absolute values and
their ratios. The gain in BW over the gain in HC ratio is strongly correlated
to the age of the newborn. It can be used from 25 to 60 weeks of age: d BW g
/ d HC cm = 44 PCA – 1138 (r = 0.973, p < 0.00001). This second way to
appreciate the adequacy of growth is interesting for length in a the fragile
neonates is not always easy to measure.
Key words: fetal growth, prematurity, nutrition, postnatal growth.
INTRODUCTION
Growth in general, and even more when it concerns a fragile neonate or child, is an
important and constant aspect of care for the family and for the medical staff (1-9).
Growth is made of different dimensions, not having the same priority at a given time (116). A compromised growth during special periods can be associated or followed by an
abnormal development (4, 12-35). The most frequently used parameters for assessing
growth are:
-
the body weight (BW) and length (BL), the circumferences of head (HC) and (left) arm,
the skin folds; these represent the absolute indices;
-
beside these we can use the relative indices such as the ponderal index, the body mass or
Quetelet’s index: they are the ratios among different parameters. These indices have the
purpose to assess the harmony of growth.
-
finally, one can also calculate the velocity indices who have the purpose to assess the
variability over a period of time of a given parameter, and hence possibly to appreciate the
influence of nutritional and or endocrine factors.
The present work makes the analysis of the different growth charts concerning the fetal,
neonatal and post neonatal periods. It aims to bring to the clinician pragmatic criteria to
appreciate the adequacy of nutrition and the longitudinal growth of the most fragile
newborns: those born before 30 weeks, those having a body weight below 1001g, those
combining a prematurity and retarded intrauterine growth. Concerning these populations,
the simple questions « which curve, what parameters of growth should be chosen? » might
become complex (12- 35b).
POPULATION, METHODS AND STATISTICS

The types of charts (18, 27-52).
1. In the fetal charts, the measurements are done by the obstetricians during intrauterine life by ultrasounds (1, 2, 3, 7, 46-52).
2. In the diagnostic charts, the measurements are done as soon as possible at birth in
babies born at different gestational ages, these being gathered in progression of
gestational age classes: the « Lubchenco », « Usher-Mclean », « Babson » and
« Dombrowski » charts are some examples of these.
3. In the combined charts, the populations include the babies measured at birth and
in their postnatal life till 60 weeks: the « Dunn », « Gairdner », « Cope »,
« Battisti » charts are representative of these. In these, growth is evaluated in a
longitudinal way. It does also exists charts for singletons, for twins and triplets,
for babies with a starting body weight < 1000g or a gestational age < 30 weeks.
All the vectors of growth are found in “Babson”, “Battisti”, “Dombrowski”,
“Gairdner”, “Lubchenco” and “Usher-Mclean” works (10, 19, 27, 32, 40, 46, 47).
For that reason, these charts have been analysed in details in the present work.

The items that were considererd:
We examined the statistical normality of the population, the body weight and length,
the head circumference, the arm circumference. We analysed the absolute weekly
gains of these parameters and also the weight over length and weight over head
circumference ratios.

The statistical calculation:
We estimated the correlations between these different indices of growth with
gestational age, searching simple and multiple regression coefficients and of
variations coefficients. We also determined the median, mean and mode values for the
data to ensure that the sample volume of population follows the criteria of normality
(53, 54).
RESULTS
1.Concerning the analysis of normality in populations presented in the different charts .
All the described charts have a sufficient sample to reach the statistical significance.
A population can be considered normal from a statistical point of view if median = mean
= mode. Moreover, the coefficient of variation of a given parameter has to be comprised
between 4 and 18 %. We can find the results in Table I. The coefficients of variation (CV
in %) is the ratio of the standard deviation over the mean times 100. The CV is calculated
for the body weight (BW), the length (BL) and the head circumference (HC). As far as
BW is concerned, one can see that normality of population is not encountered for the
charts « Lubchenco » and « Usher-Mclean ». The other parameters are in the range of
normality.
Table I .Analysis of the coefficients of variation ( CV ) for the 3 parameters of growth :
for body weight ( BW ), for length ( BL ) and for head circumference (HC).
(*) means outside the range of a normal population.
Author, year(s)
Intervals in weeks , parameters
CV : BW CV : BL
CV : HC
Babson, 1970,1976
26-42 ; 26-92 ; BW,BL,HC
14
8
9
Battisti, 1992
25-60 ; BW,BL,HC,PI
13
7
6
Dombrowski
1992, 26-42 ; BW,BL,HC
13
5.3
4
Gairdner 1971
26-60 ; BW,BL,HC
17
4.4
4
Lubchenco 1966, 1970
26-42 ; BW,BL,HC, PI
22 (*)
11
10
Usher-McLean 1969
25-44 ; BW,BL,HC
26 (*)
8
6
Among the diagnostic charts, the most normal from a statistical point of view is
« Dombrowski ». Among the combined charts, both are equivalent for the 3 considered
parameters, and the values respond to the statistical requests for a normal population.
2. About the analysis of the correlations between the different parameters of growth and the
gestational age.
The original data can be found in the respective references.
Table II. The Mathematical correlations between parameters of growth and gestational age.
Author
PCA and BW
PCA and BL
PCA and HC
Babson *
BW= 176 PCA – 3696,
BL = 0.8 PCA + 17.5,
HC= 0.48 PCA + 14,
SD = 2401 ; r = . 99
SD = 10.8 ; r = . 99
SD = 6.63 ; r =. 98
Battisti *
=174 APC – 3665,
SD = 434 ; r = .99
Dombrowski *
= 174 APC – 3732,
SD = 1262; r=.99
Gairdner *
= 206 APC – 5051,
SD = 2672; r = . 98
Lubchenco *
= 163 APC – 3375,
SD = 1303; r =. 99
Usher-McLean *
= 177 APC – 3741,
SD = 1350; r =. 99
= 0.9 APC + 11.5,
SD = 4; r= . 99
= 1.06 APC + 6.64,
SD = 7.8; r=. 99
= 0.89 APC +13.6,
SD = 13; r =. 99
= 1.25 APC + 2.5,
SD = 7.1; r =. 99
T= 1.11 APC +7,
SD = 8.35; r =. 99
= 0.6 APC + 9.72,
SD = 2.4 ; r= . 98
= 0.721 APC + 5.3,
SD = 5.3; r = . 98
= 0.5 APC + 13.94,
SD = 6.5; r = . 98
= 0.58 APC + 10.5,
DS = 4.8; r =. 97
= 0.81 APC + 3.1,
SD = 6.2; r=.99
The mathematical analysis of data in different curves gives the possibility to build up the
formulas with the coefficient of correlation (r) and of determination (r2) concerning each
parameter of growth and the gestational age (53, 54). The values of “r” (0.98 à 0.99), reflect a
high associative force between the parameters and the age of infants. Moreover, these
associations show a very good reliability: SD is comprised between 6 and 8 %. The following
formulas resume the associative relationships and may be use in either direction (PCA means
post conceptional age):
-
Weight in g = 175 PCA weeks – 3665 ( SD = 13 % )
-
Length in cm =
-
HC in cm
PCA weeks + 11
= 0.6 PCA weeks + 10
( SD = 8 %)
( SD = 6 % )
As an example, a baby of 30 weeks has a predicted weight of 1585 g, a length of 41 cm and a
HC of 28. On the other side, a weight of 5000 g correspond to a PCA of 49.5 weeks, a length
of 35 com to a PCA of 24 weeks, and a HC of 35 com to a PCA of 41.7 weeks.
3. About the analysis of the weekly increments in growth for the 3 parameters during the
different periods of post conceptional age.
The different curves are examined one by one during the different sliced periods of life. Each
parameter of growth, in the absolute and relative value, is considered from the increments
observed in the corresponding periods.
We calculated the correlations between the following ratios through all the sliced periods of
age going from 25 to 60 weeks, both in the diagnostic and in the combined curves. The
significant correlations between ages and considered ratio are the following ones:
-
[ d W g / d HC cm ] per week = 44 PCA – 1138, SD = 13 %, r = 0.973 ;
-
[ d L cm / d HC cm ] per week = 0.094 PCA – 1.543, SD 14 %, r = 0.88 ;
As an example, for a baby of 28 weeks, the ratio “d W g/d HC cm” is expected to be 94,
and the ration “ dL cm / d HC cm” is expected to be 1.09 meaning an harmonious growth
of body.
Table III. The Analysis of velocities (weekly increments) for BW, BL and HC, and also the
relative indices of them ( data with their mean and 95 % confidence intervals values).
Sliced
d BW g
d BL cm
d HC cm
dBW/dBL
dBW/dHC
dBL/dHC
115
1
1.1
115
110
0.9
(70- 160)
(.85-1.15)
(0.9 -1 .2)
(35-115)
(100-133)
(0.95-1)
145
1.13
0.9
125
164
1.34
(100- 190)
(0.63-1.63)
(0.7 – 1.3)
(90-160)
(115-213)
(0.44-2.24)
170
1.2
0.7
182
242
1.35
(108-232)
(.94– 1.54)
(0.7-1.3)
(86-288)
(117-376)
(0.9-1.79)
208
1.23
0.8
178
253
1.56
(148-268)
(.94- 1.54)
(0.65-0.95)
(70-286)
(153-353)
( 0.97-2.15)
242
1
0.7
272
392
1.5
(167-317)
(0.6 – 1.4)
(0.15-0.9)
(174-370)
(184-600)
(1.1-2.5)
213
0.8
0.5
273
459
1.8
(129 – 297)
( 0.3– 1.3)
(0.2-0.8)
(166-380)
(87-731)
(1.1-2.5)
143
0.7
0.33
310
621
2.4
(43-243)
( 0.1– 1.3)
(0.13-0.53)
(0- 645)
(0-1321)
(0.5-0.34)
70
0.25
0.17
280
420
1.47
(0 – 168)
(0 – 0.6)
(0 – 0.48)
(0 – 583)
(0 – 400)
(0- 1.25)
170
0.9
0.6
223
355
1.66
(57 – 283)
(.15 – 1.65)
(0.04-1.1)
(82-366)
(14-686)
( 0.88– 2.44)
Periods
expressed
in weeks
26-28
28-30
30-32
32-34
34-36
36-38
38-40
40-42
Mean
Conclusions concerning the analysis of the absolute values in diagnostic curves:
-
For the weight, the weekly gains are highest during the 34-36 sliced period ;
-
For the length, this highest weekly gain is observed in the 32-34 sliced period ;
-
For the head circumference, this is observed in the 28-30 weeks period.
Conclusions concerning the analysis of the relative values in diagnostic curves:
One can observe that the highest values are found at the end of pregnancy. The disparity of
the ratio “body growth over head growth” is obvious after 34 weeks, and the ratio of body
weight over length is obvious after 36 weeks.
DISCUSSION
The normal growth has always been important for the clinician. A « normal » growth is
defined by the presence of parameters being comprised in normal values and presenting a sort
of harmony between them. Normality is however differently defined among the existing
charts: either the mean and standard deviations, or the percentiles, or the mean and confidence
intervals. A growth is considered to be abnormal if the parameters are insufficient or
excessive in their absolute values, also if their velocities are outside the normal range.
The body weight is the easiest parameter to obtain. It is supposed to resume all dimensions of
growth (4, 8, 11). What the BW is concerned, the charts « Lubchenco » and « Usher-Mclean »
are questionable in order to appreciate the normality of that parameter, as the CV is largely
outside the range. The chart « Dunn » is a combined type and has a value till 60 weeks only
for the BW. The charts « Babson » and « Dombrowski » are diagnostic and meet all the
criteria of a normal population: they should be used only at birth to appreciate the preceding
fetal growth. The diagnostic charts do not offer the predictive correction due to noticeable
changes observed after birth. In case of prematurity, the fetal growth is interrupted, a period
of adaptation cannot be avoided, and one can observe changes in the priorities of growth
among organs (4, 6, 7). During the fetal period of growth, the placenta intervenes in great
part. The increasing influence of insulin during the fetal life and the later progressive
“placental fatigue” explain the shape of different diagnostic curves (2-4, 8, 12-14,68). After
birth, the endocrine and metabolic mechanisms present in neonate have to continue without
the help of placenta but hopefully with an appropriate nutrition. These aspects normally allow
the baby to reach a good growth in the different parameters (4, 6, 7, 9). In fact, beside body
weight, other parameter such as the head circumference, are also important, especially in
neonatal medicine. The HC is correlated to cerebral mass which represent a large part of
metabolism and requirements in calories and proteins. This is obvious in the previously
defined fragile babies. The most fragile babies being those born with a birth weight below
1000g or below 30 weeks, and those combining a prematurity and growth retardation
(2,3,4,5,8,9,14). Particularly in these babies, it would be better to use charts meeting the
criteria of a normal population to assess the global growth. The « Babson », « Dombrowski »,
« Gairdner » and « Battisti » charts meet the statistical criteria of normality concerning the 3
parameters. We can mention that for the first 2 weeks following birth only, the charts
« Dancis » and « Gross » are useful for following the postnatal progress of respectively the
BW and the HC. A normal growth is associated with a reduction of the mortality and
morbidity that can be observed after a prematurity and an abnormal fetal and postnatal
growth. The importance of nutrition in its quality, quantity an rapidity for an optimal long
term development have extensively been studied ( 3,4,5,8,10,13,15,16,17,18-26,46,51,55-68 ).
The combined charts take into account these facts. As it is not always easy to get all the
parameters, in order to appreciate correctly the harmony of growth, one may use two
parameters of growth (BW and HC) combined in a ratio according to a mathematical formula:
dBW in g / d HC cm = 44 PCA weeks – 1138 ( SD = 13 %, r = 0.973, p < 0.0001
On a clinical point of view, there exists hence a very strong correlation between weekly
increment in weight, HC and age, which is practical as these parameters are more easy to
obtain than the length, even if that last parameter has very important value for appreciating
« growth » (4,6,7).
To illustrate the utility of the described formula, we may consider two examples.
At 34 PCA weeks, 1 cm of gain in HC must be accompanied of a gain in BW of 358 g and
vice versa ; at 28 PCA weeks, these numbers are 94 g BW, and 422 g BW at term .
If PCA is not known, it can predict the PCA from the observed ratio[d BW / d HC ].
REFERENCES
1. Dancis J, O’Connell JR, Holt LE. A grid for recording the weight of premature infants.
J Pediatr; 1948, 33: 570-572.
2. Godwin JW, Godden JO, Chance GW. Perinatal medicine, Longman, Toronto, 1976.
3. Smith CA, Nelson NM. The physiology of the newborn. 1976, Charles C Thomas
Publisher, Springfield-Illinois.
4. Falkner F, Tanner JM. Human growth ( 2 volumes ). Baillère Tindall, 1978.
5. Sinclair JC. Temperature regulation and energy metabolism in the newborn.
Monographs in Neonatology. 1978, Grune-Stratton, New-York
6. Tanner JM. Foetus into man. 1978, Open Books, London
7. Tanner JM, Preece MA. The physiology of human growth. 1989, Cambridge
University Press.
8. Davis JA, Dobbing J. Scientific foundations of Paediatrics. 1981, Heinemann, London.
9. Polin RA, Fox WW. Feta land neonatal physiology ( 2 volumes ). 1992, WB Saunders
Company.
10. Battisti O. La croissance du prématuré en alimentation entérale: effets de la diète et du
satus pondéral à la naissance. Prix Nestlé, 1990.
11. Battisti O. Les fondements de la nutrition durant la période fœtale et néonatale.
Nutrition in the VLBW infants, XVI Annual meeting of neonatalogy; 1998, Rocourt
12. Miller HC, Merritt TA. Fetal growth in humans. 1979, Year Book Medical
Publishers, Chicago.
13. Monset-Couchard M, Minkowski A. Physiological and biochemical basis for
perinatal medicine. 1981, S Karger, Basel
14. Harding R, Bocking AD. Fetal growth and development. 2001,Cambridge University
Press.
15. Jonxis JHP. Growth and development of the full-term and premature infant. 1978,
Excerpta Medica, Amsterdam.
16. Dobbing J, Sands J. Quantitative growth and development of human brain. Arch Dis
Childh 1973; 48: 757-767.
17. Kirschbaum TH. Intrauterine growth retardation. Seminars in Perinatol, 1984,8:1-72.
18. Babson SG, Henderson NB. Fetal undergrowth: relation of head growth to later
intellectual performance. Pediatrics; 1974, 53: 890-893.
19. Gross SJ, Grimes CT, William ML. Newborn head size and neurological status. Am J
Dis Child 1978; 132: 753-756.
20. Gross SJ, Oehler JM, Eckerman CO. Head growth and development outcome in very
low-birthweight infants. Pediatrics; 1983, 71: 70-75.
21. Lucas A. Does diet in preterm infants influence clinical outcome ? Biol Neonate;
1987, suppl 52: 141-146.
22. Brennan TL, Fink SG, Frotmingham TE. Disproportionate intra-uterine head growth
and developmental outcome. Dev Med Child Neurol; 1985, 27: 746-750.
23. Clark RH, Thomas P, Peabody J. Extrauterine growth restriction remains a serious
problem in prematurely born neonates. Pediatrics ; 2003, 111: 986-990
24. Lucas A, Morley R, Cole TJ, Gore M, Lucas PJ, Crowle P, Pearse R, Boon AJ, Powell
R. Early diet in preterm babies and developmental status at 18 months. Lancet; 1990,
335: 1477-1481.
25. Lucas A, Gore SM, Cole TJ, Bamford MF, Dossetor JFB, Barr I, Dicarlo L, Cork S,
Lucas PJ. Multicentre trial on feeding low birthweight infants: effects of diet on early
growth. Arch Dis Childh; 1984, 59: 722-730.
26. Georgieff MK, Hoffman JS, Pereira GR, Bernbaum J, Hoffman-Williamson M. Effect
of neonatal caloric deprivation on head hrowth and 1-year developmental status in
preterm infants. J Pediatr ;1985, 107: 581-587.
27. Lubchenco L, Hansman C, Boyd E. intrauterine growth in length and head
circumference as estimated from live births at gestational ages from 26 to 42 weeks.
Pediatrics; 1963, 32: 793-800.
28. Usher R, McLean F. Intrauterine growth of live-born Caucasian infants at sea level. J
Pediatr; 1969, 74: 901-910.
27. Babson SJ. Growth of low-birthweight infants. J Pediatr; 1970, 77, 11-18.
28. Gairdner D, Pearson J. A growth chart for premature and other infants. Arch Dis
Childh; 1971, 46: 783-787.
29. Babson SG, Benda GI. Growth graphs for the clinical assessment of infants of
varying gestationa age. J Pediatr; 1976, 89: 814-820.
30. Largo RH, Walli R, Duc G, Fanconi A, Prader A. Evaluation of perinatal growth.
Presentation of combined intra-and extrauterine growth standards for weight, length and
head circumference. Helv Paediatr Acta; 1980, 35: 419-436.
31. Wilcox AJ. Birth weight, gestation, and the fetal growth curve. Am J Obstet Gynecol
;1981, 139: 863-867.
32. Gross SJ, Eckerman CO. Normative early head growth in very-low-birth-weight
infants. J Pediatr; 1983,103:946-949.
33. Dunn PM. A perinatal growth chart for international reference. Acta Paediatr Scand;
Suppl 1985,319:180-187.
34. Gill A, Yu VYH, Bajuk B, Astbury J. Postnatal growth in infants born before 30
weeks. Arch Dis Child; 1986, 61:549-553.
35. Georgieff MK, Sasarrow SR. Nutritional assessment of the neonate. Clinics in
Perinatol; 1986, 13:73-89.
35a. Battisti O, Swartebroeck Y, Armengol AR, Lamboray AM, Dubois P, Legrand B,
Bertrand JM, Langhendries JP. Etude comparative des différentes méthodes évaluant l’âge
gestationnel à la naissance. Rev Med Liège; 1987, 42: 780-785.
35b. Bertino E, Milani S, Fabris C, De Curtis M. Neonatal anthropometric charts: what
they are, what they are not. Arch Dis Child. Fetal Neonatal Ed.;2007,92:7-10.
36. Cope I. A perinatal growth chart for international reference. Aust N Z J obstet
Gynaecol; 1987, 27:45.
37. Larsen T, Petersen S, Greisen G, Larsen JF. Normal fetal growth evaluated by
longitudinal ultrasound examinations. Early Hum Dev; 1990, 24: 37-45.
38. Elster AD, Bleyl JL, Craven TE. Birth weight standard for triplets under modern
obstetric care in the United Sates, 1984-1989. Obstet Gynecol; 1991, 77: 387-393.
39. Medchill MT, Peterson CM, Kreinick C, Garbaciak J. Prediction of estimated fetal
weight in extremely low birth weight neonates ( 500-1000 g). Obstet Gynecol; 1991, 78:
286-290.
40. Hata T, Deter RL, Hill RM. Individual growth curve standards in triplets: prediction
of third-trimester growth and birth characteristics. Obstet Gynecol; 1991, 78: 379-384.
41. Dombrowski MP, Wolfe HM, Brans YW, Saleh AA, Sokol RJ. Neonatal
morphomtery. Relation to obstetric, pediatric and menstrual estimates of gestational age.
Am J Dis Child; 1992, 146: 852-856.
42. Arbuckle TE, Wilkins R, Sherman GJ. Birth weight percentiles by gestational age in
Canada. Obstet Gynecol; 1993, 81: 39-48.
43. Gardosi J, Chang A, Kalyan B, Sahota D, Symonds EM. Customised antenatal growth
charts. Lancet; 1992, 339: 283-287.
44. Alexander GR, Himes JH, Kaufman RB, Mor J, Kogan M. A United States national
reference for fetal growth. Obstet Gynecol; 1996, 87: 163-168.
45. Royston P, Wright EM. How to construct “normal ranges” for fetal variables.
Ultrasound Obstet Gynecol; 1998, 11: 30-38.
46. Pauls J, Bauer K, Versmod H. postnatal body weight curves for infants below 1000 g
birth weight receiving early enteral and parenteral nutrition. Eur J Pediatr; 1998, 157: 416421.
47. Ehrenkranz RA, Younes N, Lemons JA, Fanaroff AA, Donavan EF, Wright LL,
Ktasikiotis V, Tyson JE, Oh W, Shankaran S, Bauer CR, Korones SB, Stoll BJ, Stevenson
DK, Papile LA. Longitudinal growth of hospitalized very low birth weight infants.
Pediatrics; 1999, 104: 280-289.
48. Wirght CM, Booth IW, Buckler JMH, Cameron N, Cole TJ, Healy MJR, Hulse JA,
Preece MA, Reilly JJ, Williams AF. Growth reference charts for use in the United
Kingdom. Arch Dis Child; 2002, 86: 11-14.
49. Kramer MS, Morin I, Yang H, Platt RW, Usher R, McNamara H, Joseph KS, Wen
SW. Why are babies getting bigger ? Temporal trends in fetal growth and its determinants.
J Pediatr; 2002, 141: 538-542.
50. Niklasson A, Engström AL, Albertsson-Wikland K, Hellström A. Growth in very
preterm children: a longitudinal study. Pediatr Res; 2003, 54: 899-905.
51. Fenton TR. A new growth chart for preterm babies: Babson and Benda’s chart
updated with recent data and new format. BMC Pediatrics; 2003, 3:13-13.
52. Osmond TM, Bennett F, Wilks R, Forrester T. fetal growth is directly related to
maternal anthropometry and placental volume. Eur J Clin Nutr; 2004, 58: 894-900.
53. Hill AB. A short textbook of medical statistics. Unibooks, Hodder and Stoughton,
1977 London.
54. Bernard MP, Lapointe C. Mesures statistiques en épidémiologie. Presses
Universitaires du Québec, Québec 1987.
55. Atkinson SA, Bryan MH, Anderson GH. Human milk feeding in premature infants :
protein, fat and carbohydrate balances in the first two weeks of life. J Pediatr; 1981,
99:617-624.
56. Chessex P, Reichman BL, Verellen GJE, Putet G, Smith JM, Heim T, Swyer PR.
Influence of postnatal age, energy intake, and weight gain on energy metabolism ine the
very low-birth-weight infant. J Pediatr; 1981,99:761-766.
57. Chessex P, Reichman BL, Verellen GEJ, Putet G, Smith JM, Heim T, Swyer P.
Relation between heart rate and energy expenditure in the newborn. Pediatr Res; 1981, 15:
10077-1082.
58. Reichman B, Chessex P, Putet G, Verellen G, Smith JM, Heim T, Swyer PR. Diet, fat
accretion, and growth in premature infants. N Engl J Med; 1981, 305:1495-1500.
59. Gross SJ. Growth and biochemical response of preterm infant fed human milk or
midified infant formula. New Engl J Med; 1983,308:237-241.
60. Hendrickse WA, Spencer SA, Roberton DM, Hull D. The caloric intake and weight
gain of low birth weight infant fed on fresh or a special formula milk. Eur J Pediatr;
1984,143:49-53.
61. Putet G, Senterre J, Rigo J, Salle B. Nutrient balance, energy utilization, and
composition of weight gain in very-low-birth-weight infant fed pooled human milk or a
preterm formula. J Pediatr; 1984,105:79-85.
62. Roberts S, Lucas A. The effects of two extremes of dietary intake on protein accretion
in preterm infants. Early Human Dev ; 1985, 13: 301-307.
63. Michelli JL, Schütz Y. Protein metabolism and postnatal growth in very low
birthweight infants. Biol Neonate ;1987, 52, suppl 1, 25-40.
64. Lindblad BS. Perinatal nutrition. 1988, Academic press.
65. Heird WC, Kashyap S. Protein and energy requirements of low birth weight infant.
Acta Paediatr Scand ; Suppl 1989,351: 13-23.
65. Beaufrere B, Putet G, Pachiaudi C, Salle B. Whole body protein turnover measured
with 13 C-leucine and energy expenditure in preterm infants. Pediatr Res; 1990, 28: 147152.
66. Tsang RC, Lucas A, Gauy R, Zlotkin S. Nutritional needs of the preterm infant. 1993,
Williams Wilkins.
67. Räihä NC. Protein metabolism during pregnancy. 1994, Raven Press
68. Battaglia FC. Placental function and fetal nutrition.1997,Lippincott-Raven.
APPENDIX 1: DOMBROWSKI, GAIRDNER ET BATTISTI CHARTS.
-
« Dombrowski » : PCA in weeks, BW in g, BL in cm and HC in cm; mean ( SD ) ; the
original data can be found in reference 41
PCA weeks
25
26
28
30
32
34
36
38
40
42
-
BL cm
31.6 ( 2.5 )
33.1 ( 2.6 )
36.1 ( 2.8 )
39.1 ( 3 )
42.1 ( 2.5 )
44 ( 3.5 )
45.9 ( 2.4 )
47.7 ( 3.8 )
49.5 ( 2.6 )
51.3 ( 4 )
HC cm
22 ( 1.5 )
23.1 ( 1.6 )
25.3 ( 1.8 )
27.4 ( 1.9 )
29.5 ( 1.8 )
30.9 ( (2.2 )
32.2 ( 2.3 )
33.2 ( 2.3 )
34.3 ( 1.6 )
35.4 ( 2.5 )
« Gairdner » : the original data can be found in reference 28:
PCA weeks
25
26
30
34
38
42
46
50
54
60
-
BW g
560 ( 90 )
720 ( 115 )
1040 ( 200 )
1360 ( 218 )
1685 ( 275)
2093 ( 335 )
2500 ( 430 )
2932 ( 469 )
3365 ( 445 )
3798 ( 608 )
BW g
800 ( 152 )
900 ( 175 )
1300 ( 245 )
2500 ( 475 )
2900 ( 550 )
4300 ( 815 )
4700 ( 890 )
5100 ( 970 )
5500 ( 1045 )
5900 (1120 )
BL cm
35.6 ( 1.4 )
36.5 ( 1.5 )
40.3 ( 1.6 )
44.1 ( 1.5 )
47.9 ( 1.9 )
51.7 ( 2 )
55.5 ( 2.2 )
59.3 ( 2.4 )
63.1 ( 2.5 )
66.9 ( 2.7 )
HC cm
26.2 ( 1 )
26.7 ( 1 )
28.7 ( 1.15 )
30.6 ( 1.2 )
32.5 ( 1.6 )
34.6 ( 1.4 )
36.7 ( 1.5 )
38.8 ( 1.6 )
40.9 ( 1.6 )
42.8 ( 1.7 )
« Battisti » : the original data are given below and in references 10 and 11:
PCA weeks
25
26
30
34
38
42
46
50
54
60
BW g
686 ( 89 )
860 ( 112 )
1555 ( 202 )
2250 ( 293 )
2950 ( 384 )
3645 ( 474 )
4340 ( 564 )
5035 ( 654 )
5730 ( 745 )
6775 ( 880 )
BL cm
35.3 ( 2.5 )
36.2 ( 2.5 )
40 ( 2.8 )
43.8 ( 3 )
47.6 ( 3.3 )
51.4 ( 3.6 )
55.2 ( 3.9 )
59 ( 4.1 )
62.8 ( 4.4 )
68.5 ( 4.8 )
HC cm
25 ( 1.5 )
25.6 ( 1.5 )
28 ( 1.7 )
30.5 ( 1.8 )
32.9 ( 1.97 )
35.3 ( 2.1 )
37.8 ( 2.25 )
40.2 ( 2.4 )
42.6 ( 2.55 )
46.3 ( 2.78 )
APPENDIX 2: COMPLETE DATA CONCERNING « BATTISTI » ( 10,11 ) .
Material: this is a local population that has been analysed between 25 and 60 weeks post
conceptional age. Included infants had none malformations (221 were hence excluded), there
was no abnormal genetic context, were singletons and had a normal obstetrical history of
growth (863 had to be excluded). The measures were token at birth (n = 7650) and also on a
longitudinal way till PCA (n = 4848).
Population.
PCA
25 –28
29 – 31
32- 35
36 – 39
40-42
43- 60
Total
Measures at birth
Measures afterwards
468
1252
1092
2494
2344
225
598
518
1190
1118
1199
4848
7650
Total
693
1850
1610
3684
3462
1199
12498
Statististical analysis of the normality of the population at birth :
1. PCA in weeks: mean = 36 (SD=4 ), median = 36.5, mode = 37.5
2. CV in % of weight : 13 ; of length : 7 ; of HC : 6 .
multiple regressions: evolution of measured parameters of growth according to PCA:
W in g = 174 PCA weeks – 3665, r = 0.99, SD = 13 %
L in cm = 0.95 PCA + 11.53, r = 0.99, SD = 7 %
HC in cm = 0.61 PCA + 9.72, r =0.0.98, SD = 6 %
[ d W / d HC ] = 44 PCA – 1138, r =0.973, SD = 13 %
[ d L / d HC cm ] per week = 0.094 PCA – 1.543, r = 0.88 , SD 14 %
Figure 1. Reconstructed DOMBROWSKI chart:
« PCA in weeks, BW in g, BL in cm, and Hc in cm
6000
Body weight
5000
4000
Body weight
3000
-2 DS
+2 DS
2000
1000
0
25 26 28 30 32 34 36 38 40 42
PCa in weeks
70
Body length
60
50
Body length
40
-2 DS
30
+2 DS
20
10
0
25 26 28 30 32 34 36 38 40 42
PCA in weeks
45
Head circumference
40
35
30
Head
circumference
25
-2 DS
20
+2 DS
15
10
5
0
25 26 28 30 32 34 36 38 40 42
PCA in weeks
Figure 2. Reconstructed BATTISTI chart:
« PCA in weeks, BW in g, BL in cm, and HC in cm
9000
8000
Body weight
7000
6000
Body weight
5000
-2 DS
4000
+2 DS
3000
2000
1000
0
25 26 30 34 38 42 46 50 54 60
PCA in weeks
90
80
Body length
70
60
Body length
50
-2 DS
40
+2 DS
30
20
10
0
25 26 30 34 38 42 46 50 54 60
PCA in weeks
60
Head circumference
50
Head
circumference
40
-2 DS
30
+2 DS
20
10
0
25 26 30 34 38 42 46 50 54 60
PCA in weeks
Figure 3. Reconstructed GAIRDNER chart:
« PCA in weeks, BW in g, BL in cm,
and HC in cm
9000
8000
Body weight
7000
6000
Body weight
5000
-2 DS
4000
+2 DS
3000
2000
1000
0
25 26 30 34 38 42 46 50 54 60
PCA in weeks
80
70
Body length
60
50
Body length
40
-2 DS
30
+2 DS
20
10
0
25 26 30 34 38 42 46 50 54 60
PCA in weeks
50
Head circumference
45
40
Head
circumference
35
30
-2 DS
25
20
+2 DS
15
10
5
0
25 26 30 34 38 42 46 50 54 60
PCA in weeks